MUSCLE TENSION DYSPHONIA MASQUERADING AS ASTHMA

Abstract

<h3>Introduction</h3> Muscle Tension Dysphonia is a laryngeal disorder characterized as an imbalance of coordination of the laryngeal muscles. Any form of laryngeal dysfunction may masquerade as an asthma exacerbation. <h3>Case Description</h3> A 44-year-old chemistry teacher with a past medical history of well controlled asthma on budesonide/formoterol and seasonal allergic rhinitis presented with shortness of breath and "wheezing." Episodes of her dyspnea were triggered by strong scents such as hand sanitizers and household chemicals or chemical exposures in the chemistry classroom. Spirometry preformed before the episodes of dyspnea as well as during exacerbations were both reproducible and normal with no signs of bronchial obstruction or reversibility. Similarly, exhaled nitric oxide testing before exacerbation and during exacerbation, were also within normal limits on multiple readings. Despite escalating therapy in her asthma regimen, including initiating allergy immunotherapy and different rounds of biologic therapy, her symptoms persisted. Only after an ENT evaluation with a flexible laryngoscopy, was it discovered that the etiology of the patient's symptoms was due to muscle tension dysphonia—not asthma. Patient was subsequently treated with speech therapy and botulinum injections into the vocal cords with improvement of symptoms. <h3>Discussion</h3> When a patient presents with shortness of breath, providers are quick to attribute symptoms to related comorbidities when the etiology may be something else. This case highlights the importance of including muscle tension dysphonia and other laryngeal pathologies in a differential diagnosis for patients with with a history of asthma presenting with symptoms of shortness of breath resistant to escalating asthma therapy.